Use of micro and miniature position sensing devices for use in TKA and THA

ABSTRACT

A system for assisting in a surgical process, comprising: (a) a surgical device taken from a group consisting of a surgical tool and a surgical implant; (b) a positional sensor carried by the surgical device, the positional sensor including a wireless transmitter and associated circuitry for transmitting sensor data from the transmitter; and (c) a computer system including a wireless receiver and signal conditioning circuitry and hardware for converting sensor data received by the wireless receiver into at least one of (i) audio feedback of positional information for the surgical device and (ii) visual feedback of positional information for the surgical device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a Divisional Application of U.S. patent application Ser. No.10/820,279 filed Apr. 8, 2004, which claims the benefit of priority ofU.S. Provisional Patent Application Ser. No. 60/461,173 entitled “USE OFMICRO- AND MINIATURE POSITION SENSING DEVICES FOR USE IN TKA AND THA”filed Apr. 8, 2003, the disclosures of which are expressly incorporatedby reference herein in their entirety.

BACKGROUND

Image guided surgery is being evaluated to assist a surgeon inpositioning various implant components in joint arthroplasty. Theseimage-guided systems typically rely on infrared sensors to gauge theposition of the prosthetic devices and jigs in the three coordinatesystem. However, these systems are bulky and may also require one ormore of the components thereof to be mounted to bone. In addition, thesesystems require a direct line of sight that makes it difficult for thesurgeon to both operate and “stay out of the way” of the infraredtransmissions. It is highly unlikely that these bulky devices will beuseful in the small confines of minimally invasive surgery where directline of sight will be at a premium. Additionally, the time required touse these devices can extend surgery time substantially.

SUMMARY

The present invention is directed to miniature sensing devices for usein surgical procedures and devices used therein. The invention utilizes,at least in part, generally two classes of devices: micro- and miniaturesensing devices and associated micro- and miniature transmittingdevices. Data from the sensing devices may be transmitted by thetransmitting devices wirelessly to one or more data conditioning devicesthat may be operatively coupled to or include one or more displaysand/or data recording devices. In an exemplary embodiment, the sensorsinclude microgyroscopes oriented to output data relevant to three axesof position and/or movement. The microgyroscopes are operatively coupledto a wireless transmitter for transmitting the positional data to a dataconditioning device, which may be operatively coupled to or include avisual display and a data recording device. Exemplary transmissionprotocols include, without limitation, ISM (b) and FSK modulation orspread spectrum modulation.

In a further detailed exemplary embodiment, the micro- or miniaturesensors of the present invention may be mounted to surgical tools suchas individual cutting jigs, alignment instrumentation (e.g., acetabularreamers, extramedullary tibial cutter), prosthetic trials andpositioning devices (e.g., cup inserter), final prosthetic devices(e.g., central screw in acetabular shell), and/or the patient (e.g., tothe patient's bone or other tissue). The micro- or miniature sensingdevices generate data, such as position data in the three coordinates,orientation data, and/or movement data, that is transmitted to a dataconditioning device. Exemplary data conditioning devices may beoperatively coupled to or include, without limitation, visual displaysfor simulating virtual surgical environments, auditory advisory devices,and/or a computer to track the movement of the surgical device duringthe surgical procedure. The differing size restrictions for varioussurgical procedures and surgical equipment may be significant factors inthe choice of sensing devices and transmission methodology. In additionto the micro- or miniature gyroscopes, additional sensing devicesadapted for use with the present invention may include, withoutlimitation, micro- or miniature inclinometers, accelerometers, andmagnetometers.

The present invention is discussed in exemplary form with respect tojoint arthroplasty, however, the exemplary embodiments disclosed hereinmay be applicable to further surgical procedures and equipment apparentto one of ordinary skill and likewise fall within the scope of thepresent invention.

Therefore it is a first aspect of the present invention to provide asystem for assisting in a surgical process, comprising: (a) a surgicaldevice taken from a group consisting of a surgical tool and a surgicalimplant; (b) a positional sensor carried by the surgical device, thepositional sensor including a wireless transmitter and associatedcircuitry for transmitting sensor data from the transmitter; and (c) acomputer system including a wireless receiver and signal conditioningcircuitry and hardware for converting sensor data received by thewireless receiver into at least one of (i) audio feedback of positionalinformation for the surgical device and (ii) visual feedback ofpositional information for the surgical device.

It is a second aspect of the present invention to provide a system forassisting in a surgical process, comprising: (a) a surgical device takenfrom a group consisting of a surgical tool, a prosthetic component, anda surgical implant; (b) a sensor carried by the surgical device, thesensor operatively coupled to a wireless transmitter and associatedcircuitry for transmitting sensor data including at least one ofpositional data and orientational data outputted from the sensor; and(c) a computer system including a visual display, a wireless receiver,and signal conditioning circuitry and hardware for converting the sensordata received by the wireless receiver into visual feedback informationfor viewing on the visual display.

It is a third aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a surgical device,the sensor taken from the group consisting of an accelerometer, amagnetometer, a gyroscope, or an inclinometer; (b) a digital processingdevice operatively coupled to the sensor to receive data derived fromdata output from the sensor, the digital processing device generating adisplay output; and (c) a display operatively coupled to the digitalprocessing device and adapted to receive the display output, where thedisplay output displays the change in at least one of position andorientation of the sensor with respect to a point of reference.

It is a fourth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a computer system having signalconditioning hardware and software; (b) a surgical instrument having aninstrument positional sensor carried thereon, the instrument positionalsensor being operatively coupled to the signal conditioning hardware andsoftware of the computer system to transmit instrument positional datathereto; and (c) a prosthetic component having a prosthetic componentpositional sensor carried thereon, the prosthetic component positionalsensor being operatively coupled to the signal conditioning hardware andsoftware of the computer system to transmit prosthetic componentpositional data thereto.

It is a fifth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a computer system having signalconditioning hardware and software; (b) a first surgical instrumenthaving a first instrument positional sensor carried thereon, the firstinstrument positional sensor being operatively coupled to the signalconditioning hardware and software of the computer system to transmitfirst instrument positional data thereto; and (c) a second surgicalinstrument having a second instrument positional sensor carried thereon,the second instrument positional sensor being operatively coupled to thesignal conditioning hardware and software of the computer system totransmit second instrument positional data thereto.

It is a sixth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a computer system having signalconditioning hardware and software; (b) a field generating devicegenerating a detectable field approximate a reference object; and (c) atleast one of a surgical instrument and a prosthetic component having asensor carried thereon for sensing the detectable field, the sensorbeing operatively coupled to the signal conditioning hardware andsoftware of the computer system to transmit positional data theretorelative to the detectable field.

It is a seventh aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a prosthetic trial,the sensor including at least one of an accelerometer, a magnetometer, agyroscope, and an inclinometer; and (b) a wireless transmitteroperatively coupled to the sensor to disseminate broadcast data derivedfrom output data attributable to the sensor.

It is an eighth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a prostheticcomponent, the sensor including at least one of an accelerometer, amagnetometer, a gyroscope, and an inclinometer; and (b) a wirelesstransmitter operatively coupled to the sensor to disseminate broadcastdata derived from output data attributable to the sensor.

It is a ninth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a surgical jig, thesensor including at least one of an accelerometer, a magnetometer, agyroscope, and an inclinometer; and (b) a wireless transmitteroperatively coupled to the sensor to disseminate broadcast data derivedfrom output data attributable to the sensor.

It is a tenth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a surgical device,the sensor including at least one of an accelerometer, a magnetometer, agyroscope, and an inclinometer; and (b) a wireless transmitteroperatively coupled to the sensor to disseminate broadcast data derivedfrom output data attributable to the sensor, where the surgical deviceis utilized in at least one of a total knee arthroplasty procedure and atotal hip arthroplasty procedure.

It is an eleventh aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a sensor mounted to a surgical implant,the sensor including at least one of an accelerometer, a magnetometer, agyroscope, or an inclinometer; (b) a digital processing deviceoperatively coupled to the sensor to receive data derived from dataoutput from the sensor, the digital processing device generating adisplay output; and (c) a display operatively coupled to the digitalprocessing device and adapted to receive the display output, where thedisplay output displays the change in at least one of position andorientation of the sensor with respect to a point of reference.

It is a twelfth aspect of the present invention to provide a surgicaltelemetry system comprising: (a) a surgical instrument having aninstrument positional sensor associated therewith, the instrumentpositional sensor coupled to a wireless transmitter to transmit outputdata from the instrument positional sensor indicative of the position ofthe surgical instrument; (b) an implantable prosthetic device having aprosthetic device positional sensor associated therewith, the prostheticdevice positional sensor coupled to a wireless transmitter to transmitoutput data from the prosthetic device positional sensor indicative ofthe position of the implantable prosthetic device; (c) a surgical jighaving a jig positional sensor associated therewith, the jig positionalsensor coupled to a wireless transmitter to transmit output data fromthe jig positional sensor indicative of the position of the surgicaljig; (d) an anatomical positional sensor adapted to be mounted to ananatomical feature of a patient, the anatomical positional sensorcoupled to a wireless transmitter to transmit output data from theanatomical positional sensor indicative of the position of theanatomical feature; and (e) a data processing device comprising: (i) areceiver adapted to receive the transmitted output data, (ii) processingcircuitry to transform the transmitted output data, (iii) a digitaldevice operatively coupled to the processing circuitry includingsoftware operative to convert transformed sensor output data intorelative position data adapted to be viewable to reflect at least one ofposition and orientation of at least one of the surgical instrument, theimplantable prosthetic device, the surgical jig, and the anatomicalpositional sensor, and (iv) a visual display for viewing the relativeposition data.

It is a thirteenth aspect of the present invention to provide a methodof supplementing a surgical procedure using a surgical telemetry systemcomprising: (a) using a surgical device including a sensor mountedthereto, the sensor taken from the group consisting of an accelerometer,a magnetometer, a gyroscope, or an inclinometer, and the surgical devicetaken from the group consisting of a surgical instrument, a prosthesisor a surgical jig; (b) operatively coupling the sensor of the surgicaldevice to at least one of a wired receiver and a wireless receiver toreceive output data generated by the sensor indicative of at least oneof position data and orientation data; and (c) generating feedback dataderived from the output data of the sensor.

It is a fourteenth aspect of the present invention to provide a methodof manufacturing a medical device, the method comprising the steps of:(a) associating at least one of an accelerometer, a gyroscope, amagnetometer, and an inclinometer with a medical device; and (b)associating a wireless transmitter with at least one of anaccelerometer, a gyroscope, a magnetometer, and an inclinometer, wherethe wireless transmitter is adapted to transmit wireless data derivedfrom output data from at least one of the accelerometer, the gyroscope,the magnetometer, and the inclinometer.

It is a fifteenth aspect of the present invention to provide a method ofmanufacturing a prosthetic device, the method comprising the steps of:(a) associating at least one of an accelerometer, a gyroscope, amagnetometer, and an inclinometer with a prosthetic device; and (b)associating a wireless transmitter with at least one of anaccelerometer, a gyroscope, a magnetometer, and an inclinometer, wherethe wireless transmitter is adapted to transmit wireless data derivedfrom output data from at least one of the accelerometer, the gyroscope,the magnetometer, and the inclinometer.

It is a sixteenth aspect of the present invention to provide a method ofgenerating telemetry data regarding the position of an object during asurgical procedure, the method comprising the steps of: (a) receiving atransmission from a transmitter operatively coupled to at least one ofan accelerometer, a gyroscope, a magnetometer, and an inclinometerassociated with at least one of a medical device and a prosthetic deviceadapted for use with a surgical procedure; (b) processing thetransmission from the transmitter into a format amendable to visualdisplay; and (c) displaying the format onto the visual display such thatchanges in position of at least one of the medical device and theprosthetic device are reflected in substantially real-time andcorrespond substantially to an actual position of at least one of themedical device and the prosthetic device.

It is a seventeenth aspect of the present invention to provide a methodof manufacturing a surgical device, the method comprising the steps of:(a) associating at least one of an accelerometer, a gyroscope, amagnetometer, and an inclinometer with a surgical device; and (b)associating a wireless transmitter with at least one of theaccelerometer, the gyroscope, the magnetometer, and the inclinometer,where the wireless transmitter is adapted to transmit wireless dataderived from output data from at least one of the accelerometer, thegyroscope, the magnetometer, and the inclinometer.

It is an eighteenth aspect of the present invention to provide a methodof generating telemetry data regarding the position of an object duringa surgical procedure, the method comprising the steps of: (a) receivinga transmission from a transmitter operatively coupled to at least one ofan accelerometer, a gyroscope, a magnetometer, and an inclinometerassociated with at least one of a surgical device, an implant, and aprosthetic component adapted for use with a surgical procedure; (b)processing the transmission from the transmitter into a format amendableto visual display; and (c) displaying the format onto a visual displaysuch that changes in position of at least one of the medical device andthe prosthetic device are reflected in substantially real-time andcorrespond substantially to an actual position of at least one of themedical device and the prosthetic device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of the system according to anexemplary embodiment of the present invention;

FIG. 2 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 3 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 4 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 5 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 6 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 7 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 8 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 9 is a representative and schematic view of an exemplary embodimentof the present invention;

FIG. 10 is a representative and schematic view of an exemplaryembodiment of the present invention;

FIG. 11 is a representative and schematic view of an exemplaryembodiment of the present invention;

FIG. 12 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 13 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 14 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 15 is an X-ray taken of the representative view of FIG. 14;

FIG. 16 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 17 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 18 is a representative view of an exemplary embodiment of thepresent invention;

FIG. 19 is a schematic representation of an alternate exemplaryembodiment of the present invention;

FIG. 20 is a representation illustrating movements of a body for sensingby a gyroscope sensor according to an exemplary embodiment of thepresent invention;

FIG. 21 is a schematic representation of a gyroscope sensor for use withan exemplary embodiment of the present invention; and

FIG. 22 is a schematic circuit diagram representation of a three-axismagnetic field detector set up.

DESCRIPTION OF THE PRESENT INVENTION

The present invention is directed to systems and associated methods thatmay provide visual or other telemetry regarding the orientation and/orposition of surgical devices and jigs, anatomical features, and/or finaland trial prosthetic components for use with surgical procedures suchas, without limitation, total hip arthroplasty and total kneearthroplasty.

As discussed herein, the present invention may be incorporated withvarious medical devices such as, without limitation, saws, drills,hammers, reamers, screwdrivers, cup alignment instruments, guide-rods ofan intramedullary femoral and tibial cutting jig, and extramedullaryfemoral and tibial cutting jigs. The invention may also be incorporatedwith various final and trial prosthetic components such as, withoutlimitation, cup inserters, screw cap domes, prosthetic knee tibialtrays, prosthetic knee trial stems, prosthetic knee trial tibial trays,prosthetic knee femoral components, prosthetic knee trial femoralcomponents, and intramedullary extensions and stems. Still further, theinvention may also be incorporated with implanted devices notencompassed by prosthetics or prosthetic trails.

Referring to FIG. 1, the invention utilizes one or more micro- orminiature sensors 10 mounted to or within (carried by) a surgical device12, an anatomical feature of a patient 14, and/or a final or trialprosthetic component 16 to generate feedback or telemetry data during asurgical procedure regarding the position and/or orientation of thedevice, anatomical feature, and/or the component alone, with respect toone another, and/or with respect to a reference point. As discussed inmore detail below, each micro- or miniature sensor 10 outputs dataregarding position, orientation and/or movement of that sensor which isindicative of the position and/or orientation of the device, anatomicalfeature, or component which carries it. In specific embodiments, suchoutput data is generated in real-time and continues to be generated in athree dimensional coordinate system as the sensor changes positionand/or orientation.

The sensor output data may be utilized to generate a visualrepresentation of the position and/or orientation of the device,anatomical feature, or component using a visual display 18. A displaysystem 20 may include signal conditioning hardware and software 21 forreceiving sensor data from the sensor and for converting such sensordata into a visual image on a visual display 18 operatively coupledthereto or included therewith. Exemplary visual displays may include,for example and without limitation, a television screen, a computermonitor, a projected image, and a virtual reality headset/visor. In thismanner, a surgeon (or any other party) can visually discernsubstantially in real-time the position and/or orientation of thedevice, feature, or component and any changes thereto during a surgicalprocedure within the operating room or even from a remote location. Thismay be particularly useful during surgical procedures where a directline of sight from a particular angle may not be possible, for instance,in minimally invasive surgery characterized by small incisionalopenings.

The conditioning hardware and software 21 of the display system 20 mayhave access to three dimensional maps of the surgical devices andprosthetic components, including data indicative of the location of themicro- or miniature sensors carried thereby, to facilitate thegeneration of an electronic 3-D image of the devices and prostheticcomponents. With these 3-D maps in place, the sensor output data may beassociated with the 3-D images to create correlated 3-D data in aone-to-one manner showing any actual change in position of the device orcomponent. It is likewise within the scope of the invention that theimage data is not generated in a one-to-one manner such that the deviceor component may be visually magnified for viewing ease and effect.Generally, an increase in the number of strategically positioned sensorscarried by a particular surgical device will result in a more accuratethe 3-D correlation.

Many applications of the present invention will involve providingadditional micro- or miniature reference sensors 22 on one or morereference objects so that the conditioning hardware and software 21 ofthe display system 20 will be configured to generate displaysrepresenting the position, orientation and/or movement of the surgicaldevices with respect to the reference object(s). Exemplary referenceobjects may include a patient's bone or other point on the patient'sanatomy, an implant, a prosthetic trial component, a final prostheticcomponent, another surgical tool or instrument, a device worn by thepatient, and an operating room object such as an operating table orrestraining device. Such reference sensors will also output dataregarding position, orientation and/or movement indicative of theposition and/or orientation of the device, anatomical feature, orcomponent which carries it. In specific embodiments, such output data isgenerated in real-time and continues to be generated in a threedimensional coordinate system as the reference sensor changes positionand/or orientation. The reference sensor output data may be utilized togenerate a visual representation of the position and/or orientation ofthe reference device, anatomical feature, or component using the visualdisplay 18. In specific embodiments, the conditioning hardware andsoftware 21 of the display system 20 may have access to threedimensional maps of the reference objects, including data indicative ofthe location of the reference micro- or miniature sensors 22 carriedthereby, to facilitate the generation of an electronic 3-D image of thereference objects.

An exemplary use of the present invention includes “targeting”.Targeting includes identifying the relative location and/or orientationof one or more surgical devices, prosthetic components, implants,anatomical features, and surgical jigs. An exemplary instance mayinclude a prosthetic trial femoral component being coupled to a surgicalstem inserter by way of a threaded interface between the stem of theinserter and the proximal shoulder of the trial femoral component foruse in a total hip arthroplasty procedure. After the trial femoralcomponent is positioned within the femur, the inserter may be rotated todisengage from the femoral component so that the surgeon may test therange of motion of the patient's hip without having the inserter as anobstruction. Targeting includes utilizing sensors or other articlesassociated with the trial component to ascertain the position and/ororientation of the trial component, as well as sensors or other articlesassociated with the inserter to ascertain the position and/ororientation of the inserter. Thus, the surgeon can align the inserterwith the opening within the shoulder of the trial femoral component andengage the inserter with the trial femoral component to facilitateremoval of the trial femoral component without with a direct line ofsight, such as, without limitation, in minimally invasive surgery. It isto be understood that targeting simply refers to knowing the positionand/or orientation of at least one of a surgical device, a prostheticcomponent, an implant, an anatomical feature, and a surgical jig withrespect to a point of reference, and optionally being able to engage ordisengage a device without a direct line of sight.

Further exemplary uses of the present invention include monitoring theprogress of a surgical instrument, such as the current depth of areaming instrument, toward the intended goal position, which may or maynot be or include a reference object. An exemplary monitoring functionmight also include providing orientation and position feedback such ashow far apart a device or tool is from a prosthetic component or whetheror not the surgeon is correctly orienting the surgical instrument, theprosthetic component, or the surgical jig with respect to an intendedtarget position and/or orientation.

The surgical devices, prosthetic components, implants, and surgical jigsinclude one or more micro- or miniature sensors 10 that output dataregarding the position, orientation, and/or movement of structuresmounted thereto or incorporated therewith. In an exemplary form, themicro- or miniature sensors may include three or more microgyroscopescarried by the device, component, implant, or jig 12 that arepositioned/oriented such that each microgyroscope outputs data regardingchanges in one of the X, Y, and Z planes in a three dimensionalcoordinate system. The microgyroscopes are operatively coupled to one ormore micro- or miniature RF transmitters 24 that are also carried by thedevice, component, implant, or jig 12, where the RF transmittertransmits sensor output data from the microgyroscopes to an RF receiver26 provided by the display system 20. As discussed above, the surgicaldevices, prosthetic components, and surgical jigs may be 3-D mapped toassist the conditioning hardware and software 21 of the display system20 in generating an electronic, virtual representation of the surgicaldevice, prosthetic component, implant, or surgical jig on the associateddisplay. Sensor output data is utilized by the conditioning hardware andsoftware 21 of the display system 20 to impart substantially real-timeposition, orientation, and/or movement to the virtual representationshown on the display screen 18.

Referencing FIG. 2, a first detailed exemplary application of thepresent invention includes a surgical reamer 30 adapted for use with atotal hip arthroplasty procedure and having at least one micro- orminiature sensor 32 associated therewith. An exemplary sensor 32 mayinclude individually or in combination, without limitation,inclinometers, accelerometers, magnetometers, and microgyroscopes. Thesensor 32 is coupled to a micro- or miniature transmitter device 34,which may be carried on the surgical reamer 30, to wirelessly broadcastsensor data regarding the position and/or orientation of the surgicalreamer 30 with respect to the pelvis 36 in three axes of movement,represented by planes β, α and θ. A wireless receiver 38, operativelycoupled to a display system 40, receives the signals broadcast by thetransmitter 34 and forwards the data derived from the signals fordisplay upon the system 40. The display system 40 is designed to informthe surgeon regarding the position and/or orientation of the surgicalreamer 30, for example, continuously during surgery. In a furtherexemplary embodiment, the surgical reamer 30 may include one or moremicro- or miniature sensors strategically carried thereon capable ofsensing changes in position, orientation, and/or movement in one or moreof the axes of movement.

In a more detailed exemplary embodiment, films of a patient to undergototal hip arthroplasty are taken preoperatively and are utilized tocreate registration and calculate the depth of acetabular reamingnecessary during the procedure. Thereafter, such calculations are inputinto a data positioning device 42, operatively coupled to the display40, to reflect the position of the reamer 30 with respect to thepatient's pelvis 36. Alternatively, the data positioning device 42 maybe operatively coupled to the reamer 30 to interface with the sensor 32and measure conditions indicative of the orientation and/or position ofthe reamer 30 relative to the current depth of the reaming and/or thepredetermined depth necessary for proper reaming. In accordance with thepredetermined calculations, where such measurements may be independentof bone position, the reamer 30 may be automatically stopped or slowedif the desired position and/or orientation of the reamer is outside of apredetermined tolerance. By way of example, and not a limitation, thereamer 30 may be slowed or turned off if the orientation and/or positiondata reflects that too deep of a depression is being created by thesurgeon reaming the acetabulum of the pelvis 36. Likewise, if thereaming appears to be awry from the intended orientation, the reamerwill slow or stop to discontinue reaming in the awry orientation.

Referring to FIGS. 3 and 4, a second detailed exemplary application mayinclude one or more micro- or miniature sensors 52 associated with asurgical drill 50 and an intramedullary hole starter 50′ that may beused in a total knee arthroplasty procedure to facilitate correctpositioning of the intramedullary stems and placement of theintramedullary locator. Exemplary sensors 52 may include individually orin combination, without limitation, inclinometers, accelerometers,magnetometers, and microgyroscopes. The sensor 52 may be coupled to amicro- or miniature transmitter device 54, which may also be carried onthe surgical drill 50 or the intramedullary hole starter 50′, towirelessly broadcast sensor data regarding the position and/ororientation of the surgical drill and bit 50 or the intramedullary holestarter 50′ with respect to a patient's femur 56 in three axes ofmovement, represented by planes A, B, and C. A wireless receiver 58,operatively coupled to a display system 60, receives the signalsbroadcast by the transmitter 54 and forwards the data derived from thesignals for display upon the system 60. The display system 60 isdesigned to inform the surgeon regarding the position and/or orientationof the surgical drill 50 or the intramedullary hole starter 50′ toensure proper alignment with respect to the femur 56. In a furtherexemplary embodiment, the surgical drill 50 and/or the intramedullaryhole starter 50′ may include at least three micro- or miniature sensorsstrategically carried thereon capable of sensing changes in position,orientation, and/or movement in three axes. In yet another exemplaryembodiment, the surgical drill 50 and/or the intramedullary hole starter50′ may include fewer than three sensors providing position and/ororientation data in less than three axes of movement.

Referencing FIGS. 4 and 5, in a more detailed exemplary embodiment,films of a patient to undergo total knee arthroplasty are takenpreoperatively and are utilized to calculate the depth of drillingnecessary for proper accommodation of one or more surgical jigs 62 andcomponent stems. Thereafter, such calculations are input into a datapositioning device 64, operatively coupled to the display 60 to reflectthe position of the drill 50 with respect to the patient's femur 56.Alternatively, the data positioning device 64 may be operatively coupledto the drill 50 to interface with the sensor 52 and measure conditionsindicative of the orientation and/or position of the drill 50 relativeto a predetermined depth. In accordance with the predeterminedcalculations, the drill 50 may be automatically stopped or slowed if thedesired position and/or orientation of the drill bit is outside of apredetermined tolerance. By way of example, and not a limitation, thedrill 50 may be slowed or turned off if the orientation and/or positiondata reflects that the alignment of the drill bit is off from apredetermined acceptable tolerance. In addition, if the drilling appearsto be at or approaching the intended depth, the drill 50 may slow orstop to discontinue drilling.

Further exemplary embodiments may include a surgical saw including oneor more micro- or miniature sensors associated therewith for use duringa total knee arthroplasty procedure. Exemplary sensors may includeindividually or in combination, without limitation, inclinometers,accelerometers, magnetometers, and microgyroscopes. Each sensor isoperatively coupled to a feedback device, such as a display system, toprovide information to a surgeon regarding the position and/ororientation of the surgical saw. For instance, the surgeon may want toverify the depth of cutting to ensure that tissue damage outside of thatexpected does not occur. Exemplary components of a feedback device mayinclude, without limitation, the display system introduced above, aswell as an auditory feedback device such as an earpiece speaker. In eachinstance, the feedback device is designed to inform the surgeonregarding the position and/or orientation of the surgical instrumentduring surgery.

A third detailed exemplary application may include one or more micro- orminiature sensors associated with a surgical instrument and one or moremicro- or miniature reference sensors associated with a selectedanatomical feature to monitor the position of the instrument relative tothe anatomical feature and possibly cease or slow operation of theinstrument upon reaching a predetermined position relative to theanatomical feature. More detailed exemplary applications include totalhip arthroplasty where one might prevent: (1) reaming too deep duringacetabular preparation; (2) over-penetration during drilling ofacetabular screw holes; (3) over-penetration during depth gauging ofacetabular screw holes; (4) broaching too deep; and (5) inadequatereaming of the acetabulum.

Referencing FIG. 6, a surgical reamer 70 includes at least onemagnetometer 72 operatively coupled to a transmitter 74 that may becarried by the reamer 70. A number of magnets 76 may be implantedcircumferentially around an acetabulum 78 of a pelvis 80, where themagnets may have varying field strengths. The position of the reamer 70may be measured in part using the earth's magnetic field, and morespecifically, using the magnetic fields generated by the magnets 76positioned about the acetabulum 78. Still further, an artificialmagnetic field may be selectively created by a field generating device82 to facilitate gauging the position of the reamer 70 independent ofthe pelvis 80. As the position of the reamer 70 in any of the three axesof movement is changed, the magnetometer 72 may detect the earth'smagnetic field and/or the artificial magnetic field. The magnetometer 72may be coupled to a data positioning device 84 capable of utilizing themagnetometer 72 output to discern the changes in position of the reamer70. Those of ordinary skill in the art are aware of the practicesthrough which magnetometers 72 may be used to monitor changes inposition. In addition, the magnetometer 72 may likewise detect magneticfields and field strengths associated with the magnets 74 to providerelevant magnetic field data to the positioning device 84 to calculatethe relative position of the reamer 70 with respect the magnetspositioned around the acetabulum 78, and thereby the pelvis 80. The datapositioning device 84 may be operatively coupled to a display or datareadout 86 to enable the surgeon to reposition the reamer 70, based atleast in part, upon the outputted data. In this manner, a surgeon mayreposition and align the reamer 70 without requiring a direct line ofsight. It is to be understood that other sensors may be used in place ofthe magnetometers and magnets to facilitate positioning and orientingthe reamer 70 with respect to the acetabulum 78.

A further detailed exemplary application includes microgyroscopesmounted within the femoral broaches to determine the broach positionwithin the femoral canal. In another detailed exemplary application,circular gyro rings are positioned distally along the femur tosupplement the orientation and alignment of the broach within thefemoral canal.

In a fourth detailed exemplary application, one or more micro- orminiature sensors are associated with a surgical instrument and one ormore micro- or miniature reference sensors are associated with asurgical jig to monitor the position of the instrument with respect tothe jig and possibly cease operation of the instrument upon reaching apredetermined position relative to the jig. Exemplary sensors to beassociated with a surgical instrument include, without limitation,accelerometers, inclinometers, magnetometers, and gyroscopes. Moredetailed exemplary applications include: (1) ensuring that the saw isinserted and operative to a proper depth through a slot in the jig (noregistration); (2) ensuring that the proper orientation (correctvalgus/varus/slope) is achieved while cutting with a saw (withregistration); and (3) ensuring proper drill penetration through anacetabular screw hole (independent of bone registration). Still further,exemplary sensors to be associated with a surgical jig include, withoutlimitation, accelerometers, inclinometers, magnetometers, andgyroscopes. Exemplary positioning for the sensors associated with thejigs include, without limitation, within the guide rods ofintramedullary femoral and tibial cutting jigs and/or extramedullaryfemoral and tibial cutting jigs to ensure that correct orientationexists between the saw and the jig prior to any bone being cut.

Referencing FIG. 7, an exemplary embodiment may include a surgical saw90 that includes one or more microsensors 92 associated therewith. Themicrosensors 92 may be coupled to a wireless transmitter 94 carried bythe saw 90 or may simply include leads from the surgical saw 90 coupledto a data positioning device 96. When wireless transmitters 94 areutilized, a wireless receiver 98 may be included to capture the wirelesssignals and forward such data to the data positioning device 96.Likewise, a surgical knee jig 100 for use with a total knee arthroplastyprocedure includes one or more microsensors 102, within the guide rod103, coupled to a transmitter 104 associated therewith that outputgenerated data that is received by the data positioning device 96. Thesurgical jig 100 is adapted to be mounted to the distal end of a femur106 to prepare the distal end to accept a prosthetic femoral component(not shown). The data positioning device 96 utilizes the data from themicrosensors 92, 102 to output data reflecting the relative position ofthe saw 90 with respect to the jig 100 that may be viewed by a surgeonon a visual display 108. Such data may be indicative of the depth of thecut as the position of the saw 90 changes with respect to the jig 100,thereby allowing the surgeon to know the depth of the cut withoutnecessitating a direct line of sight. It will be understood by one ofordinary skill that the cuts made by the saw 90 do not requireregistration to bone, but instead utilize the relative position and/ororientation of the intramedullary guide rod 103. It is to be understoodthat the microsensors associated with the surgical jig 100 need not beidentical in number and in function to those associated with thesurgical saw 90.

In a fifth detailed exemplary application, one or more micro- orminiature reference sensors are associated with an anatomical featureand one or more micro- or miniature sensors are associated with amedical instrument adapted to position a prosthetic device. The sensorsallow for the monitoring of the position of the prosthetic device withrespect to the anatomical feature to ensure proper alignment of theprosthetic device. It is within the scope of the invention thatanatomical features include, without limitation, bone, muscle, tendons,ligaments, and skin. In instances where a small incision is made andother internal landmarks may not be apparent, a combination of sensorson an anatomical feature and a medical instrument may assist in accurateplacement of a prosthetic component without necessitating a direct lineof sight.

Referencing FIG. 8, a surgical cup inserter 110 includes at least onemicrogyroscope 112 operatively coupled to a wireless transmitter 114that may be carried within the handle of the inserter 110. Themicrogyroscope 112 may be capable of sensing changes in movement in allthree axes of movement and, via the transmitter 114, disseminating suchposition data to a remote receiver 116. The remote receiver 116 isoperatively coupled to a data positioning device 118 adapted to utilizethe microgyroscope 112 output data to determine the relative position ofthe inserter 110 with respect to an anatomical feature (not shown). Inan exemplary form, the anatomical feature may include the pelvis havingone or more sensors mounted thereto that are operatively coupled to thedata positioning device 118. Such sensors may be wired or wireless andinclude wireless transmitters where applicable. In an exemplary process,the pelvis (not shown) includes sensors positioned approximate theacetabulum to provide reference data in at least one dimension and areference point for comparative analysis of the position data output bythe microgyroscope 112. As such, the data positioning device 118 is ableto calculate the position of the inserter 110 with respect to thepelvis, even as the position of the inserter 110 changes with respect tothe pelvis. The data positioning device 118 may be operatively coupledto a display monitor 120 to display the relative position of theinserter 110 with respect to the pelvis, including the angle ofinsertion of the prosthetic cup 122 within the acetabulum. This angledata may allow the surgeon to compare the current angle with apredetermined angle (which may have been calculated preoperatively usingone or more X-rays or other position determining devices) and guideplacement of the prosthetic cup into the correct abduction andanteversion orientation with respect to the acetabulum.

Referring to FIG. 9, a sixth detailed exemplary application may includeone or more micro- or miniature sensors 130 mounted inside a prosthetictrial component 132 to identify if the trial component is orientedcorrectly with respect to an anatomical feature 134. More specifically,the prosthetic trial component, or femoral knee trial prosthesis 132,includes one or more sensors 130 associated therewith that sense changesin orientation in free space and output such data to a wirelesstransmitter 134 within the trial 132. The anatomical feature, or femur136, includes micro- or miniature sensors 138 mounted thereto during atotal knee arthroplasty procedure. The outputs of the sensors 138 may becoupled to a wireless transmitter (not shown) or may be coupled directlyto a data position device 140 also receiving inputs indirectly from themicro- or miniature sensors 130 within the femoral knee prosthesis 132.A visual display 142 may be operatively coupled to the data positioningdevice 140 to provide a visual representation, capable of rotation inthree space, to enable the surgeon to see what cannot be seen via adirect line of sight.

Referencing FIG. 10, an alternate exemplary embodiment of the sixthaspect may include one or more micro- or miniature sensors (not shown)mounted inside a prosthetic trial component 152 to identify if the trialcomponent is oriented correctly with respect to an anatomical feature154. More specifically, the prosthetic trial component, or femoral hiptrial prosthesis 152, includes one or more sensors associated therewiththat sense changes in orientation in free space and output such data toa wireless transmitter (not shown) within the trial component 152. Theanatomical feature, or femur 154, includes a micro- or miniature sensor156 mounted thereto during a total hip arthroplasty procedure. Theoutput of the sensor may be coupled to a wireless transmitter (notshown) or may be coupled directly to a data position device 156 alsoreceiving inputs indirectly from the micro- or miniature sensors withinthe femoral hip trial prosthesis 152. A visual display 158 may beoperatively coupled to the data positioning device 156 to provide avisual representation, capable of rotation in three space, to enable thesurgeon to see what cannot be seen via a direct line of sight. Morespecifically, the orientation of the trial component 152 may bemonitored to verify that the trial component is within the femoral canalin varus or valgus. Still further, the relative anteversion of the stemof the femoral hip trial 152 may also be determined.

In still a further exemplary application, one or more micro- orminiature sensors may be mounted to trial prosthetic components toprovide relevant data to optimize range of motion of the prostheticjoint by selecting final prosthetic components that mitigate dislocationtendencies. In addition, such trial prosthetic components may providerelevant data regarding ligament balance and joint kinematics functiontesting relevant to final prosthetic component selection.

In a seventh detailed exemplary application, one or more micro- orminiature sensors may be mounted to a prosthetic trail component.Prosthetic trail components are utilized by a surgeon to verify therelevant dimensions of the eventual prosthetic component to beimplanted. In addition to sensing three dimensional positional data,such sensors may measure absolute values and range of motion to discernwhich prosthetic components fit best in a particular patient. Suchmeasurements may also be compared to the position of one or moreanatomical features, such as bone, where the bone has a micro- orminiature reference sensor mounted thereto or in proximity thereto. Suchprosthetic components may be used with or without registration and maybe utilized in a wide range of surgical procedures beyond total hiparthroplasty and total knee arthroplasty.

Referencing FIG. 11, a seventh exemplary application may include one ormore micro- or miniature sensors 190 mounted inside a prosthetic trialcomponent 192 to provide feedback regarding the orientation of the trialcomponent 192 during a total hip arthroplasty procedure. Morespecifically, the prosthetic trial component, or femoral hip trialprosthesis 192, includes one or more sensors 190 associated therewiththat sense changes in position and/or orientation in free space andoutput such data to a wireless transmitter 194 within the prosthesis 192while the trial is repositioned with respect to the femur 194. A dataposition device 196 receives signals from the transmitter 194 andcalculates the position of the prosthesis 192 and any changes inposition in real-time. Visual representation regarding the orientationof the prosthesis 192 may be shown on a visual display 198 operativelycoupled to the data position device 196. The visual display 198 may beprogrammed to concurrently show the position of the prosthesis 192 andthe position of the patient's bone from preoperative X-rays or otherdata that effectively show the relative anatomical position of thepatient. More specifically, the orientation of the trial 192 may bemonitored to verify that the trial 192 is within the femoral canal 200in varus or valgus. Still further, the relative anteversion of the stemof the femoral trial 192 may also be determined.

Referencing FIG. 12, in a further detailed exemplary application, asurgical instrument 210 and prosthetic trial component 212 each havemicro- or miniature sensors (not shown) associated therewith to provideguidance to maneuver the instrument 210 and trial 212 for insertion,impaction, and/or extraction of the trial 212. More specifically, thesurgical instrument may include a surgical stem inserter 210 having athreaded end adapted to be received within an opening on the shoulder ofa trial femoral prosthetic component 212. As discussed in a previousexemplary application, such an exemplary surgical instrument andexemplary prosthetic trial component may be useful in minimally invasivesurgery where direct line of sight may not continuously be possible.Still further, such an exemplary surgical instrument and exemplaryprosthetic trial component may be particularly useful in targeting andfacilitate coupling and disengagement between the trials and surgicalinstruments without necessitating a direct line of sight or an undulylarge incision.

Referring to FIG. 13, an eighth detailed exemplary application mayinclude one or more micro- or miniature sensors 216 mounted to a tibialtray prosthetic device 218 to provide positional and/or orientationalinformation sufficient to discern if subsidence is occurring subsequentto total knee arthroplasty. Still further, one or more micro- orminiature sensors (not shown) may be mounted on a femoral prostheticdevice 220 to provide positional and/or orientational informationsufficient to discern if the prosthetic knee joint 222 and the range ofmotion associated therewith are within proper tolerances. Suchinformation could be compared to data generated during prosthetic trialfittings, where the prosthetic trials included one or more micro- orminiature sensors, to verify that the final prosthetic components aremimicking the final prosthetic trial components on which the surgeonbased the choice of final prosthetic components.

In a further detailed exemplary application, the position and depth of afemoral prosthetic shaft within the femoral canal could be monitoredover time to determine if subsidence or loosening was occurring after atotal hip arthroplasty procedure.

In a ninth detailed exemplary application, one or more micro- orminiature sensors may be mounted to a prosthetic device or surgicalretainer. A further detailed exemplary application includes associatingone or more micro- or miniature sensors along an outer rim of aprosthetic cup to facilitate aligning and orienting the cup within theacetabulum. An additional exemplary embodiment includes one or moremicrogyroscopes placed within a femoral component trial to providerelevant data to determine varus and valgus and flexion and extensionalignment relative the center of the femoral canal. An even furtherexemplary use may include mounting a micro- or miniature sensor to boththe acetabulum and femoral component trials (in the femoral neck or inthe femoral head) to discern the relative stability (range of movement(ROM) and angle of dislocation) between the two components.

Referencing FIGS. 14 and 15, a femoral rod 153 for use in repair of afractured femur 155 may include one or more micro- or miniature sensors151 associated therewith. The rod 153 includes a plurality of holes 157therethrough that are adapted to receive screws 159 to mount the rod 153to the femur 155. However, before the screws 159 are introduced therein,a corresponding hole must be drilled through the femur 155 that isprecisely aligned with one of the holes of the rod 153. One challenge tosurgeons has been discerning the position and orientation of the holes157, then maintaining the position and orientation of holes 157 whiledrilling through the femur 155. Prior art techniques involved X-raymachines that were cumbersome and hindered the range of motion of thesurgeon. The present invention, however, does not necessitate use ofcumbersome X-ray machines, but relies upon the sensor or sensors 151associated with the rod 153 to discern the position of the holestherethrough. Exemplary sensors 151 may include individually or incombination, without limitation, inclinometers, accelerometers,magnetometers, and microgyroscopes. The sensor 151 may be coupled to amicro- or miniature transmitter device to transmit sensor data regardingthe position and/or orientation of the rod 153 in three axes ofmovement, represented by planes X, Y, and Z. A wireless receiver,operatively coupled to a display system, receives the signals broadcastby the transmitter and forwards the data derived from the signals fordisplay upon the system. The display system is designed to providefeedback for the surgeon regarding the position and/or orientation ofone or more holes within the rod 153.

In a further exemplary application, a surgical drill may include one ormore micro- or miniature sensors associated therewith, along with afemoral rod that includes one or more micro- or miniature sensorsassociated therewith for use in repair of a fractured femur. Asdiscussed above, the rod includes a plurality of holes therethrough thatare adapted to receive screws to mount the rod to the femur. The sensorsassociated with the rod provide position and/or orientation dataregarding the holes through the rod, while the sensors associated withthe drill provide position and/or orientation data regarding theposition and/or orientation of the drill bit to align the drill bit withthe holes in the rod without necessitating a direct line of sight priorto commencing the drilling. As discussed above, utilizing positionaland/or orientational sensors alleviates the reliance upon cumbersomeX-ray equipment.

In still a further exemplary application, one or more micro- orminiature sensors may be mounted to a prosthetic component to providerelevant data regarding the range of motion available to the patient. Inaddition, prosthetic components having one or more micro- or miniaturesensors associated therewith may be compared against data generated bytrial prosthetic components to compare the range of motion available tothe patient. Still further, such prosthetic components may providerelevant data regarding ligament balance and joint kinematics functiontesting prior to termination of the surgical procedure. Even further,such prosthetic components may include sensors capable of generatingpositional and/or orientational data such that ligament balance andjoint kinematics function can be assessed and compared to previousmeasurements to discern what, if any, changes have occurred over time.

Referencing FIG. 16, a tenth detailed exemplary application may includeone or more micro- or miniature sensors mounted to a screw cap domescrew 161 to identify the position of a final prosthetic hip component.In one exemplary application, the screw cap dome screw 161 providesfeedback regarding the orientation of the insert 163 within the cup 165secured to the pelvis 167 to ensure that the insert 163 is adequatelyimpacted and adjacent to the cup 165. In another exemplary application,the sensors may provide position and/or orientation data over time thatmay be detected and recorded to discern if one or more of the finalprosthetic hip components have graduated in position and/or orientationover time.

In an eleventh detailed exemplary application, one or more micro- orminiature reference sensors are associated with an anatomical featureand one or more micro- or miniature sensors are associated with aprosthetic device. The sensors allow for the monitoring of the positionof the prosthetic device with respect to the anatomical feature to trackchanges in the relationship between the prosthetic device and theanatomical feature over time. More specifically, the anatomical featuremay include a patient's femur and the prosthetic device may include afemoral stem for use in a total hip arthroplasty procedure. Stillfurther, the anatomical feature might comprise a patient's tibia and theprosthetic device may include a tibial tray for use in a total kneearthroplasty procedure.

Referencing FIG. 17, a femoral prosthetic component 171 includes atleast one or more micro- or miniature reference sensors 173 operativelycoupled to a wireless transmitter 175. The sensor 173 may be capable ofsensing changes in movement in all three axes of movement and, via thetransmitter 175, disseminating such position data to a remote receiver.The remote receiver may be operatively coupled to a data positioningdevice adapted to utilize the sensor 173 output data to determine therelative position of the femoral prosthetic component 171 with respectto an anatomical feature, such as, without limitation, a patient's femur177. In an exemplary form, the femur 177 may include one or more sensors179 mounted thereto that are operatively coupled to the data positioningdevice. Such sensors may be wired or wireless and include wirelesstransmitters where applicable. In an exemplary process, the sensors 179associated with the femur 177 provide reference data in at least onedimension and a reference point for comparative analysis of the positionand/or orientation data output by the sensors 173 associated with thefemoral prosthetic component 171. As such, the data positioning deviceis able to calculate the position of the femoral prosthetic component171 with respect to the femur 177, even as the position of theprosthetic component 171 changes with respect to the femur 177. The datapositioning device may be operatively coupled to a display monitor todisplay the relative position of the prosthetic component 171 withrespect to the femur 177, including the angle of insertion of theprosthetic component 171 within the femur 177. This angle data may allowthe surgeon to compare the current angle with a predetermined angle(which may have been calculated preoperatively using one or more X-raysor other position determining devices) and guide placement of theprosthetic component into the correct position.

In a twelfth detailed exemplary application, one or more micro- orminiature reference sensors are associated with an implant, independentof a prosthetic or trial component, a surgical device, or a surgicaljig. The implant may be positioned within an anatomical feature, suchas, without limitation, the femoral canal. Likewise, the implant may bepositioned adjacent to an anatomical feature, such as withoutlimitation, the femoral bone. By using an implant with one or moremicro- or miniature reference sensors, a point of reference may beestablished that is relatively fixed over time and in proximity to thearea in which the surgeon is concerned.

Referencing FIG. 18, an exemplary application may include one or moremicro- or miniature sensors 191 associated with an implant 193.Exemplary sensors 191 may include individually or in combination,without limitation, inclinometers, accelerometers, magnetometers, andmicrogyroscopes. The sensor 191 may be coupled to a micro- or miniaturetransmitter device 195 to transmit sensor data regarding the positionand/or orientation of the implant 193 in three axes of movement. Awireless receiver, operatively coupled to a display system, receives thesignals broadcast by the transmitter 195 and forwards the data derivedfrom the signals for display upon the system. The display system isdesigned to provide a reference point for the surgeon regarding theposition and/or orientation of one or more surgical instruments, finaland trial prosthetic components, and surgical jigs used during asurgical procedure.

In a further exemplary embodiment, the implant 193 is inserted into afemoral canal 197 of a patient's femur 199 during a total hiparthroplasty procedure. In such an exemplary embodiment, a prostheticfemoral component 201 likewise includes one or more micro- or miniaturesensors 203 associated therewith and in communication with a wirelesstransmitter 205 that provides relevant data regarding the position ofthe femoral component 201. Likewise, the implant 193 may providerelevant data that is imputed to the position and/or orientation of apatient's femur 199. In this manner, the surgeon can precisely make oneor more cuts with a surgical saw (not shown) concerning the proximalportion of the patient's femur 199 prior to insertion of the prostheticcomponent 201. In addition, when the prosthetic component 201 is readyfor insertion, the surgeon may leave the implant 193 in place and mayutilize the position data from the sensors 191 as a point of referencefor positioning and orienting the prosthetic component 201.

It is also within the scope of the present invention to replace one ormore of the reference sensors with transmitting devices, such as,without limitation, magnets. In this manner, the signal or fieldgenerated may be detected by one or more reference sensors, such as,without limitation, magnetometers. Likewise, other transmitting devicesand sensors, such as piezoelectric sensors, known to those of ordinaryskill will likewise fall within the scope of the present invention.

While some of the aforementioned exemplary embodiments have beendiscussed with respect to total hip arthroplasty or total kneearthroplasty, the same principles and advantages are likewise applicablefor other medical procedures where microgyroscopes or other sensors maybe mounted to one or more surgical devices, anatomical features,implants, and prosthetic components to ensure that the object isoriented properly with respect to one or more points of reference.

Current technology in reference sensors such as that disclosed in UnitedStates Patent Application Publication Nos. 2002/0180306 and2002/0104376, the disclosures of which are hereby incorporated byreference, evidences substantial development in reducing the size ofsuch sensors utilizing nanotechnology.

The exemplary sensors discussed herein and adapted for use with thepresent invention may fall within generally two classes: source andsourceless. Source sensors rely on artificial stimuli such as generatedmagnetic fields or outputs from other artificial devices for one or morepoints of reference. In exemplary form, a pair of source sensors mayrely on each other for relative points of reference. In a furtherexemplary form, a first sensor may be mounted to a first object and areference sensor may be mounted to a second object, where the firstsensor utilizes a magnetic field or other output generated by thereference sensor to provide a reference point as to the movement of thesecond sensor with respect to the first sensor. Likewise, the referencesensor may utilize a magnetic field or other output from the firstsensor as a reference point as to the movement of the reference sensorwith respect to the first sensor. In this manner, a surgeon is able tomanipulate a first object having the first sensor mounted thereto withrespect to the second object with the second sensor mounted theretowithout necessitating a direct line of sight to position the firstobject in relation to the second object.

A second class of sensors, sourceless sensors, relies on natural orever-present stimuli such as the earth's magnetic field or gravity.Exemplary sourceless sensors may utilize the magnetic field and/orgravity of the earth to provide a fixed reference point for measurementssuch as tilt and level. Such sensors may be self-contained and, unlikesome source sensors, do not require a transducer to create an artificialstimulus or field.

As shown in FIG. 19, a first exemplary sensor technology available foruse with the present invention is the Flock of Birds, and morespecifically, the microBIRD technology commercially available fromAscension Technology Corporation (seehttp://www.ascension-tech.com/products/microbird.php), and patented inU.S. Pat. Nos. 4,849,692 and 4,945,305, the disclosures of which areincorporated herein by reference. Flock of Birds is amagnetic-transducing technique that measures the position andorientation of one or more receiving antenna sensors 10′ located on thesurgical device, tool, prosthetic component, or implant 12′ with respectto a transmitter 22′ located on a reference object 16′. The transmitter22′ includes three individual antennae arranged concentrically togenerate a multiplicity of DC magnetic fields that are picked up by thesensor 10′. The sensor measures the position and orientation of theobject 16′ which carries it. The sensor 10′ consists of three axes ofantenna that are sensitive to DC magnetic fields. The transmitter 22′includes a driver that provides a controlled amount of DC current toeach axis of the transmitter. Both the sensor 10′ and the transmitter22′ driver may be modified in the present invention to facilitatewireless communication with the display system 20′. The display system20′ controls the amount of DC current provided by the transmitter 22′driver to the transmitter 22′ axis. The signal output from the sensor10′ is transmitted back to the conditioning hardware and software 21′ ofthe display system 20′, which conditions and processes the signal tocompute position and orientation of the sensor 10′ with respect to thetransmitter 22′ using the Flock of Birds available algorithms. Suchposition and orientation data is then used to generate a visual signalto be displayed on the visual display 18′.

A second exemplary sensor technology for use with the present inventionmay include microgyroscopes to measure angular rate; i.e., how quicklyan object turns. The rotation is typically measured with reference toone of three axes: X, Y, and Z or yaw, pitch, and roll. A microgyroscopewith one axis of sensitivity can also be used to measure other axes bymounting the microgyroscope differently, as shown in FIG. 20. Here, ayaw-axis microgyroscope is mounted on its side so that the yaw axisbecomes the roll axis. Depending on how a microgyroscope is mounted, itsprimary axis of sensitivity can be one of the three axes of motion: yaw,pitch, or roll.

Exemplary microgyroscopes for use with the present invention includeADXRS150 available from Analog Devices (http://www.analog.com). Suchexemplary microgyroscopes are rotational rate measurement systems on asingle monolithic integrated circuit. The exemplary microgyroscopesmeasure angular rate by means of Coriolis acceleration. Each of threemicrogyroscopes may be oriented with respect to the surgical device,tool, prosthetic component, or implant so that each of the X, Y, and Zplanes is accommodated.

One practical application is to measure how quickly a surgicalinstrument is turned by mounting one or more microgyroscopes thereto. Inaddition, the angular rate can be integrated over time to determineangular position. For example, if a microgyroscope senses that thesurgical instrument is out of position, an appropriate signal mayindicate such to the surgeon and discontinue operation of the instrumentuntil the instrument is oriented in a proper manner.

Referencing FIG. 21, an exemplary microgyroscope 242 includes a frame248 containing a resonating mass 250 tethered to a substrate by springs252 at 90° relative to the resonating motion to measure the Coriolisacceleration. A plurality of Coriolis sense fingers 254 are used tocapacitively sense displacement of the frame in response to the forceexerted by the mass. If the springs 252 have a stiffness, K, then thedisplacement resulting from the reaction force will be 2 ΩvM/K. As therate of rotation with respect to the microgyroscope 242 increases, sodoes the displacement of the mass 250 and the signal derived from thecorresponding capacitance change. It should be noted that themicrogyroscope 242 may be mounted anywhere on the surgical device, tool,prosthetic component, or implant and at any angle, so long as thesensing axis of the microgyroscope 242 is parallel to the axis ofrotation. The microgyroscopes 242 measure the displacement of theresonating mass 250 and its frame 248 due to the Coriolis effect throughcapacitive sensing elements attached to a resonator. Displacement due toangular rate induces a differential capacitance in this system. If thetotal capacitance is C and the spacing of the sense fingers 254 is “g”,then the differential capacitance is 2 ΩvMC/gK, and is directlyproportional to the angular rate. The fidelity of this relationship isexcellent in practice, with nonlinearity less than 0.1%.

The microgyroscopes 242 can sense capacitance changes as small as12×10⁻²¹ farads (12 zeptofarads) from deflections as small as 0.00016Angstroms (16 femtometers). This can be utilized in the surgical device,tool, prosthetic component, or implant by situating the electronics,including amplifiers and filters, on the same die as the gyroscope 242.The differential signal alternates at the resonator frequency and can beextracted from the noise by correlation.

The exemplary ADXRS microgyroscopes 242 employ two resonators thatoperate anti-phase to differentially sense signals and rejectcommon-mode external accelerations that are unrelated to angular motionto angular rate-sensing that makes it possible to reject shocks of up to1,000 g. As a result, the microgyroscopes 242 measure the same magnitudeof rotation, but give outputs in opposite directions. Therefore, thedifference between the two outputs is used to measure angular rate. Thiscancels non-rotational signals that affect both ends of themicrogyroscope 242.

Accelerometers may also be utilized as sensors 10, 10′ in the presentinvention to measure tilt or inclination, inertial forces, and shock orvibration. An intended application for accelerometers with respect tothe present invention includes measuring tilt in at least one axis andexemplary accelerometers are available as model ADXL203BE from AnalogDevices (http://www.analog.com). Such exemplary accelerometers areacceleration measurement systems on a single monolithic integratedcircuit to implement an open loop acceleration measurement architecture.It is envisioned that the accelerometer be oriented with respect to thesurgical device, tool, prosthetic component, or implant so theaccelerometer's X and Y axis would most often approach a parallelorientation with respect to the earth's surface. In such an orientation,tilt may be measured in two axes for roll and pitch. In addition tomeasuring acceleration, the acceleration may be integrated over time toprovide velocity data, which can likewise be integrated over time toprovide position data. Those of ordinary skill are familiar with thenoise considerations associated with power supplies for sensors, and inparticular, accelerometers. It is within the scope of the invention toutilize a capacitor, generally around 1 μF, to decouple theaccelerometer from the noise of the power supply. Other techniques mayinclude adding a resistor in series with the power supply or adding abulk capacitor (in the 1 μF to 4 μF range) in parallel with the firstcapacitor (1 μF).

Other exemplary accelerometers include model KXG20-L20 available fromKionix, Inc. (http://www.kionix.com), model SCA610 Series available fromVTI Technologies Oy (http://www.vti.fi), model SQ-XL-DAQ from(http://signalquest.com). The SQ-XL-DAQ functions as a self containeddata acquisition system for 2 axis or 3 axis acceleration, tilt, andvibration measurement when used with a serial interface cable.

It is envisioned that accelerometers may be used in combination withgyroscopes, where gyroscopes detect rotation and where theaccelerometers detect acceleration, for sensing inertial movement withina three-dimensional space.

It is also within the scope of the present invention that sensors 10,10′ include inclinometers to measure roll angle and pitch angle in oneor more of the exemplary embodiments discussed above. An exemplaryinclinometer for use with the present invention is model SQ-S12X-360DAfrom Signal Quest, Inc. (http://www.Signalquest.com). Such an exemplaryinclinometer provides both an analog voltage output and a digital serialoutput corresponding directly to a full-scale range of 360° of pitchangle and 180° of roll angle. Another exemplary inclinometer for usewith the present invention is model SCA61T Series available from VTITechnologies Oy (http://www.vti.fi). The measuring direction for thisexemplary inclinometer is parallel to the mounting plane.

It is also within the scope of the invention that the sensors 10, 10′include magnetometers for detecting an artificial magnetic field and/orthe earth's magnetic field and discerning positional data therefrom. Anexemplary magnetometer for use with the present invention is modelCXM544 available from Crossbow Technology, Inc. (http://www.xbow.com).The magnetometer is capable of detecting the earth's magnetic field inthree axes and computes a continuous measure of orientation using a3-axis accelerometer as a gravitational reference field. Themagnetometer compensates for temperature drift, alignment, and othererrors.

Another exemplary magnetometer for use with the present inventionincludes model HMC1053 available from Honeywell, Inc.(http://www.magneticsensors.com). Such an exemplary magnetometerincludes a wheatstone bridge to measure magnetic fields. With powersupply applied to a bridge, the sensor converts any incident magneticfield in the sensitive axis direction to a differential voltage output.In addition to the bridge circuit, the sensor has two on-chipmagnetically coupled straps; the offset strap and the set/reset strap.These straps are for incident field adjustment and magnetic domainalignment, and eliminate the need for external coils positioned aroundthe sensors. The magnetoresistive sensors are made of a nickel-iron(Permalloy) thin-film deposited on a silicon wafer and patterned as aresistive strip element. In the presence of a magnetic field, a changein the bridge resistive elements causes a corresponding change involtage across the bridge outputs. These resistive elements are alignedtogether to have a common sensitive axis (indicated by arrows) that willprovide positive voltage change with magnetic fields increasing in thesensitive direction. Because the output only is in proportion to theone-dimensional axis (the principle of anisotropy) and its magnitude,additional sensor bridges placed at orthogonal directions permitaccurate measurement of arbitrary field direction. The combination ofsensor bridges in two and three orthogonal axes permits applicationssuch as compassing and magnetometry.

Referring to FIG. 22, an exemplary three-axis magnetic field detectormay comprise a two-axis detector combined with a single axis detector.Alternatively a single three axes detector may be used in place of theabove combination.

In accordance with the present invention, the sensors may be connectedto one or more displays and digital recording devices via wire and/orwireless transmission. A first exemplary embodiment includes a sensoroperatively coupled to a radio frequency (RF) modem that may include aprogrammed microprocessor (i.e., a smart modem). The microprocessor mayorganize the data into discrete packets and address such packets forreception by intended remote displays and/or digital recording devices.Each of the displays and/or digital recording devices also include asmart modem operative to automatically discern if the data is corruptedand if the data is intended for that particular remote device. If thedata is corrupted, the smart modem will signal the disseminating modemto resend the data. The packetizing and addressing of the packetsreduces interference and enables the same radio frequency to be utilizedby each of the smart modems.

Alternatively, the present invention may utilize dumb modemstransmitting data on a predetermined frequency. One of ordinary skill isfamiliar with the software and hardware that may be associated with adumb modem to provide addressing and data packetization.

It is also within the scope of the invention that the sensors beoperatively coupled to a dumb modem and radio frequency transmitter thatmanipulates the data output from the sensors and converts it into aradio signal. The radio signal is adapted to be received by one or moreremote devices, where a modem operatively coupled thereto converts theradio signals into data indicative of data output by the sensorsregarding at least one of position, acceleration, and velocity.

An exemplary RF modem may utilize an RF spread spectrum radiotransmitter or may utilize another RF communication protocol.

Following from the above description and invention summaries, it shouldbe apparent to those of ordinary skill in the art that, while theapparatuses described herein constitutes an exemplary embodiments of thepresent invention, the invention contained herein is not limited to thisprecise embodiments and changes may be made to the aforementionedembodiments without departing from the scope of the invention as definedby the claims. Additionally, it is to be understood that the inventionis defined by the claims and it is not intended that any limitations orelements describing the exemplary embodiments set forth herein are to beincorporated into the interpretation of any claim element unless suchlimitation or element is explicitly stated. Likewise, it is to beunderstood that it is not necessary to meet any or all of the identifiedadvantages or objects of the invention disclosed herein in order to fallwithin the scope of any one of the claims, since the invention isdefined by the claims and since inherent and/or unforeseen advantages ofthe present invention may exist even though they may not have beenexplicitly discussed herein.

1. A surgical telemetry system comprising: a sourceless bone sensorcoupled to a portion of an extremity of a patient and generating motionsignals in at least two degrees of freedom; a reference sensor coupledto a reference of the patient, the reference sensor generating motionsignals in at least two degrees of freedom; a processing systemoperatively coupled to the sensors to acquire the motion signals andgenerate a feedback output; and a feedback device operably coupled tothe processing system to receive and present the feedback output to auser, the feedback output representing one of a position and anorientation of the portion of the extremity based on the motion datawith respect to the reference.
 2. The system of claim 1, wherein theportion of the extremity is a bone.
 3. The system of claim 2, whereinthe sourceless bone sensor is implanted in the bone.
 4. The system ofclaim 3, further comprising a prosthetic component, wherein theprosthetic component includes the sourceless bone sensor.
 5. The systemof claim 2, wherein the sourceless bone sensor is coupled to a jig whichis coupled to the bone.
 6. The system of claim 1, wherein the portion ofthe extremity comprises a prosthesis.
 7. The system of claim 1, whereinthe motion signals represent motion from at least one of a firstposition and a first orientation to a second position and a secondorientation of the sensors.
 8. The system of claim 1, wherein thesourceless bone sensor comprises an integrated circuit generating motionsignals corresponding to three degrees of freedom.
 9. The system ofclaim 1, wherein the feedback device is a display device and thefeedback output is an image.
 10. The system of claim 1, wherein thefeedback device is a sound generator and the feedback output is anaudible sound.
 11. The system of claim 1, wherein the processing systemwirelessly acquires the motion data.
 12. The system of claim 1, whereinthe reference sensor is carried by a surgical instrument.
 13. The systemof claim 1, wherein the reference sensor is carried by a secondprosthetic component.
 14. The system of claim 1, wherein the referencesensor is coupled to a portion of an extremity of a patient in apredetermined relation to a second bone of the patient.
 15. The systemof claim 14, wherein the second bone comprises the pelvic bone.
 16. Thesystem of claim 1, wherein the motion signals represent at least one ofa position and an orientation of the sensors.
 17. A surgical telemetrysystem for repairing a joint of a patient including a first jointsurface adjacent a second joint surface, the system comprising: asourceless bone sensor coupled to a portion of an extremity of a patientincluding the first joint surface, the sourceless bone sensor generatingmotion signals in at least two degrees of freedom; a reference sensorcoupled to a reference of the patient, the reference sensor generatingmotion signals in at least two degrees of freedom; a processing systemoperatively coupled to the sensors to acquire the motion signals andgenerate a feedback output; and a feedback device operably coupled tothe processing system to receive and present the feedback output to auser, the feedback output representing one of a range of movement and anangle of dislocation of the portion of the extremity based on the motiondata with respect to the reference.
 18. The system of claim 17, whereinthe portion of the extremity is a bone.
 19. The system of claim 18,wherein the sourceless bone sensor is implanted in the bone.
 20. Thesystem of claim 19, further comprising a prosthetic component, whereinthe prosthetic component includes the sourceless bone sensor.
 21. Thesystem of claim 18, wherein the sourceless bone sensor is coupled to ajig which is coupled to the bone.
 22. The system of claim 17, whereinthe portion of the extremity comprises a prosthesis.
 23. The system ofclaim 17, wherein the sourceless bone sensor comprises an integratedcircuit generating motion signals corresponding to three degrees offreedom.
 24. The system of claim 17, wherein the feedback device is adisplay device and the feedback output is an image.
 25. The system ofclaim 17, wherein the feedback device is a sound generator and thefeedback output is an audible sound.
 26. The system of claim 17, whereinthe processing system wirelessly acquires the motion data.
 27. Thesystem of claim 17, wherein the reference sensor is coupled in apredetermined relation to a second bone of the patient including thesecond joint surface.
 28. The system of claim 27, wherein the secondbone comprises the pelvic bone.
 29. A method of generating telemetrydata in a surgical procedure, the method comprising the steps of:generating motion signals with a sourceless object sensor coupled to anobject; generating motion signals with a reference sensor coupled to areference of the patient; acquiring motion data based on the motionsignals, the motion data including at least one of an object positionand an object orientation; generating a feedback output based on themotion data, the feedback output representing a spatial relationshipbetween the object and the reference on the patient; and presenting thefeedback output to a user in substantially real-time.
 30. The method ofclaim 29, wherein the object is a surgical tool.
 31. The method of claim30, wherein the second bone comprises the pelvic bone.
 32. The method ofclaim 29, wherein the object is a bone of the patient.
 33. The method ofclaim 32, wherein the sourceless object sensor is implanted in the bone.34. The method of claim 29, wherein the object is a jig coupled to thebone of the patient.
 35. The method of claim 29, wherein the sourcelessobject sensor comprises an integrated circuit generating motion signalscorresponding to three degrees of freedom.
 36. The method of claim 29,wherein the feedback output is an image.
 37. The method of claim 29,wherein the feedback output is an audible sound.
 38. The method of claim29, further comprising the step of wirelessly acquiring the motion data.39. The method of claim 29, wherein the reference sensor is coupled to asecond bone of the patient.